Tobacco 21 Violation Please complete this form if you believe that a tobacco retailer in Howard County has violated the Tobacco 21 law by: Selling tobacco products to anyone under the age of 21 and/or Failing to keep tobacco products secured behind the counter in an area accessible only to the licensed retailer and employees Question Title * 1. Today’s Date Date Date Question Title * 2. Describe the violation Retailers Information Question Title * 3. Retailer’s Information Name of Business Street Address City Zip Code Question Title * 4. Provide your name and contact information if you would like to be contacted by a Howard County Health Department representative. First Name Last Name Phone Number Email Done